Provider Demographics
NPI:1609957463
Name:JORDAN, DANNY (MPT)
Entity Type:Individual
Prefix:
First Name:DANNY
Middle Name:
Last Name:JORDAN
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42080 STATE STREET
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-5173
Mailing Address - Country:US
Mailing Address - Phone:760-568-2894
Mailing Address - Fax:760-346-4179
Practice Address - Street 1:42080 STATE STREET
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-5173
Practice Address - Country:US
Practice Address - Phone:760-568-2894
Practice Address - Fax:760-346-4179
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT27640225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
2233960OtherFIRST HEALTH
5673015OtherFIRST HEALTH
P00328755OtherPALMETTO GBA
2233960OtherFIRST HEALTH
5673015OtherFIRST HEALTH